Role of Sonoelastography in Evaluation of Lymph Node Metastasis in Head and Neck Keeping Histopathology as Gold Standard

Maaza Javed; Saulat Sarfraz; Nawal Naseem; Abdullah Javed; Saadullah Javed; Hafiz Abad Mahmood

doi:10.70749/ijbr.v3i5.1086

Authors

Maaza Javed Shaikh Zayed Hospital, Lahore, Punjab, Pakistan.
Saulat Sarfraz Shaikh Zayed Hospital, Lahore, Punjab, Pakistan.
Nawal Naseem Shaikh Zayed Hospital, Lahore, Punjab, Pakistan.
Abdullah Javed Poonch Medical College, Rawalakot, Pakistan.
Saadullah Javed Allama Iqbal Medical College, Lahore, Punjab, Pakistan.
Hafiz Abad Mahmood Shaikh Zayed Hospital, Lahore, Punjab, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i5.1086

Keywords:

Sonoelastography, Cervical Lymph Nodes, Malignancy, Diagnostic Accuracy, Histopathology

Abstract

Objective: To determine the diagnostic accuracy of sonoelastography in the evaluation of lymph node metastasis in head and neck cancer, using histopathology as the gold standard. Research Design: A study of cross-sectional validation. Duration and Place of Study: This research was carried out in the Diagnostic Radiology Department, Shaikh Zayed Hospital, Lahore, from May 2024 to November 2024. Methodology: A total of 138 patients aged 18 to 70 years, with enlarged cervical lymph nodes (≥1 cm), were included. Participants were evaluated using sonoelastography, a high-resolution ultrasound-based technique, performed by an experienced radiologist. Elastographic tissue stiffness was scored from 1 to 4, with scores 1 and 2 indicating benign nodes and scores 3 and 4 indicating malignancy. The reference standard for biopsy sample analysis was histopathological analysis. The following metrics were computed: diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: The mean age of participants was 55.19 ± 5.67 years, with a mean lymph node size of 2.16 ± 0.22 cm. Sonoelastography identified 38.4% of lymph nodes as malignant and 61.6% as benign, compared to histopathological findings of 30.4% malignant and 69.6% benign. Diagnostic performance metrics for sonoelastography included sensitivity of 86%, specificity of 82%, PPV of 68%, NPV of 93%, and an overall diagnostic accuracy of 83%. Conclusion: Sonoelastography demonstrates high sensitivity and diagnostic accuracy in evaluating cervical lymph nodes, making it a valuable, non-invasive adjunct to conventional imaging methods.

Downloads

Download data is not yet available.

References

Jeong, S. Y., Park, H., Kim, M. S., Kang, J. H., Paik, E. S., Lee, Y., Kim, T. J., Lee, J. W., Kim, B., Bae, D. S., & Choi, C. H. (2020). Pretreatment lymph node metastasis as a prognostic significance in cervical cancer: Comparison between disease status. Cancer Research and Treatment, 52(2), 516-523.

https://doi.org/10.4143/crt.2019.328

Ji, H., Hu, C., Yang, X., Liu, Y., Ji, G., Ge, S., Wang, X., & Wang, M. (2023). Lymph node metastasis in cancer progression: Molecular mechanisms, clinical significance and therapeutic interventions. Signal Transduction and Targeted Therapy, 8(1).

https://doi.org/10.1038/s41392-023-01576-4

Johnson, D. E., Burtness, B., Leemans, C. R., Lui, V. W., Bauman, J. E., & Grandis, J. R. (2020). Head and neck squamous cell carcinoma. Nature Reviews Disease Primers, 6(1).

https://doi.org/10.1038/s41572-020-00224-3

Ah-Thiane, L., Rousseau, C., Aumont, M., Cailleteau, A., Doré, M., Mervoyer, A., Vaugier, L., & Supiot, S. (2023). The Sentinel lymph node in treatment planning: A narrative review of lymph-flow-Guided radiotherapy. Cancers, 15(10), 2736.

https://doi.org/10.3390/cancers15102736

Wang, B., Guo, Q., Wang, J., Yu, Y., Yi, A., Cui, X., & Dietrich, C. F. (2021). Ultrasound Elastography for the evaluation of lymph nodes. Frontiers in Oncology, 11.

https://doi.org/10.3389/fonc.2021.714660

Vineela, E., Sakalecha, A. K., & Narayanrao Suresh, T. (2022). Role of Sonoelastography in differentiating benign from malignant cervical lymph nodes and correlating with pathology. Cureus, 14(3).

https://doi.org/10.7759/cureus.22984

Cui, X., Li, K., Yi, A., Wang, B., Wei, Q., Wu, G., & Dietrich, C. F. (2022). Ultrasound elastography. Endoscopic Ultrasound, 11(4), 252-274.

https://doi.org/10.4103/eus-d-21-00151

Tseng, L. J., Matsuyama, A., & MacDonald-Dickinson, V. (2023). Histology: The gold standard for diagnosis?. The Canadian Veterinary Journal, 64(4), 389.

https://pmc.ncbi.nlm.nih.gov/articles/PMC10031787/

Sigrist, R., Liau, J., Kaffas, A. E., Chammas, M. C., & Willmann, J. K. (2017). Ultrasound Elastography: Review of techniques and clinical applications. Theranostics, 7(5), 1303-1329.

https://doi.org/10.7150/thno.18650

Tunçez, H. Ç., Koç, A. M., Adıbelli, Z. H., Arslan, F. Z., Argon, A., & Oğuzdoğan, G. Y. (2023). Diagnostic efficacy of ultrasonography, Doppler ultrasonography and elastography in the evaluation of suspected malignant lymph nodes. Journal of Ultrasonography, 23(92), e1-e9.

https://doi.org/10.15557/jou.2023.0001

Vineela, E., Sakalecha, A. K., & Narayanrao Suresh, T. (2022). Role of Sonoelastography in differentiating benign from malignant cervical lymph nodes and correlating with pathology. Cureus.

https://doi.org/10.7759/cureus.22984

Seetharam, M., Prakash, M. C., Pradeep, H. N., Nanjaraj, C. P., Narayana, M., Ramakrishnaiah, R. A., Kerekoppa, A. R., & Chandura, T. P. (2022). Role of Sonoelastography for differentiating benign and malignant cervical lymph nodes: A cross-sectional study. INTERNATIONAL JOURNAL OF ANATOMY RADIOLOGY AND SURGERY, 11(1).

https://doi.org/10.7860/ijars/2022/50838.2729

Ghajarzadeh, M., Mohammadifar, M., Azarkhish, K., & Emami-Razavi, S. H. (2014). Sono-elastography for differentiating benign and malignant cervical lymph nodes: a systematic review and meta-analysis. International Journal of Preventive Medicine, 5(12), 1521.

https://pmc.ncbi.nlm.nih.gov/articles/PMC4336982/

Alam, F., Naito, K., Horiguchi, J., Fukuda, H., Tachikake, T., & Ito, K. (2008). Accuracy of Sonographic Elastography in the differential diagnosis of enlarged cervical lymph nodes: Comparison with conventional B-mode sonography. American Journal of Roentgenology, 191(2), 604-610.

https://doi.org/10.2214/ajr.07.3401

Pehlivan, M., Gurbuz, M. K., Cingi, C., Adapinar, B., Değirmenci, A. N., Acikalin, F. M., Pinarbaşli, M. Ö., & Colak, E. (2019). Diagnostic role of ultrasound elastography on lymph node metastases in patients with head and neck cancer. Brazilian Journal of Otorhinolaryngology, 85(3), 297-302.

https://doi.org/10.1016/j.bjorl.2018.01.002

Rubaltelli, L., Stramare, R., Tregnaghi, A., Scagliori, E., Cecchelero, E., Mannucci, M., Gallinaro, E., & Beltrame, V. (2009). The role of sonoelastography in the differential diagnosis of neck nodules. Journal of Ultrasound, 12(3), 93-100.

https://doi.org/10.1016/j.jus.2009.05.001

Prabakaran, L., Aiyappan, S. K., Ramesh, S., Ramesh, R., & Kumaran, S. (2024). Diagnostic accuracy of spectral Doppler indices and Sonoelastography in predicting malignancy in breast imaging reporting and database system 3 breast lesions with histopathology as the reference standard. Cureus, 16(11).

https://doi.org/10.7759/cureus.73481

Li, H., Cong, P., Yu, Y., & Zhang, Y. (2024). Value of sonoelastography for diagnosis of breast non-mass lesions and comparison with BI-RADS: A systematic review and meta-analysis. Medicine, 103(23), e38425.

https://doi.org/10.1097/md.0000000000038425